When now Colorado Governor Jared Polis was merely a freshman Congressman, he called a town hall at the Singletree Pavilion in Edwards on the proposed Affordable Care Act. I remember attending. It was packed. Many people listened from outside through the open doors. Palpable tensions wafted through the air.
Congressman Polis said something to begin that I remember. What he said legitimized and disarmed the crowd. To paraphrase from recollection Polis said, half of you trust the government more than private industry to serve your interests and half of you trust private industry to serve your interests more than the government. This discussion will not change that. I want to acknowledge those core perspectives to start this off…
The 10-year birthday of ACA amid this escalating COVID-19 pandemic underscores the wisdom of those words, and the tension is baked into the Federalist Papers and our founding documents. The balance of who believes which of those more has changed dramatically through U.S. history. Right now, more than ever, we must talk in an informed and critical way about the motivations, strengths, and weaknesses of the private sector as well as government.
“When the person next to you in line might infect you, suddenly universal health care seems more reasonable,” argues Craig R. McCoy in the Philadelphia Inquirer also published in Governing.
Amid all that unites us, I think Congressman Polis was on to something when he started by acknowledging this core philosophical difference especially as the winds of change shift. It is at the root of nearly all our political differences today and worth acknowledging. Put it on the table. Use it as a prism through which to view the news because the Socialism vs Democracy debate is a dichotomy being actively exploited to our collective detriment. It is also a meaningless rabbit hole to debate because it obscures an extraordinarily intricate spectrum of interrelationships between the private sector and “the government” that make civil society and the economy function.
For years now, liberals and conservatives have undersold the benefits that a well-run government delivers to people. This has made improving longstanding policy that needs to be updated impossible, not to mention tackling major issues that can only be tackled effectively at a federal level like health care and infrastructure difficult. The effect of our inability to act affects each of us, and all of us collectively. We have failed to draw compelling narratives between our lives and our policy. Circumstances may change that. The Colorado Sun today had an opinion piece drawing a direct line from the passage of ACA to a cancer survivor and how we approach cancer as a nation. Expect more of that. We should not avoid politics, but we should start with policy first, and do so while respecting core ideas instead of blocking a policy discussion with ideological labels.
What was said at that Polis town hall for ACA was an expose on concerns that stem from those core perspectives worth revisiting. They stem from very human concerns about change and control. The crowd gathered there reflected strong feelings Americans had about nearly every major aspect of the legislation. While many implored to not be separated from “their doctor,” neither employees nor employers were satisfied with the skyrocketing cost of paying for care (other than those already on Medicare). Many were afraid that with years of 10% or more annual increases they were slowly being priced out of coverage which was financially strangling employees as well as employers – and that was when they were healthy. Others were concerned that government getting more involved in care or insurance would raise taxes. Hospitals complained of emergency rooms being inundated by people who didn’t belong there. Those who went later complained of extraordinary expenses. At the time, more than 156 million Americans, about half, faced giving up employer-based insurance if a single-payer system were introduced. That was scary. There was rhetoric about government “death panels” choosing who would be insured for what. Some of us feared our teeth might become as bad as the English. Many were anxious about the government making decisions which they freely allowed for-profit insurers to make. Few directly defended the insurers who at the time could refuse to provide coverage based what seemed like an increasing number of loopholes, not least of which were preexisting conditions. In the wealthiest nation on Earth, an extraordinary number of citizens were one medical incident away from bankruptcy and a cycle of perpetual poverty, unless you were over 65 or a Veteran in systems insured by the government. Many people rolled the dice and just didn’t have insurance. In the Vail Valley, it seemed the number of fundraisers held for people with cancer or other major conditions increased by the week. Remember?
Monday (3/23/2020) marked the 10th birthday of the passage of the ACA. To quote the headline in the Huffington Post, ’10 Years and One Pandemic Later, Obamacare’s Impact is a lot Clearer: The ACA’s shortcomings are more obvious. So are it’s strengths.’ No one thought it was perfect then. It was supposed to be a first step, a work in progress and grow. It was an act passed following the 2008 economic catastrophe during a rare 2-year alignment when both branches of Congress and the White House aligned politically and mustered just enough a will to get something important accomplished. It was also based on a precarious three-legged stool which has been under attack since day one, and recently by all three branches of the federal government (coverage of pre-existing conditions, the individual mandates, subsidy for lower incomes including Medicaid expansion).
The lead up to the adoption of ACA, and how wobblingly it has endured is captured in Arguing with Zombies, a compilation of Paul Krugman columns in which he argues that ideology has crippled our ability to act effectively on policy. He says, “To get effective reform, however, we’ll need to shed some preconceptions—in particular, the ideologically driven belief that government is always the problem and market competition is always the solution.”
If the ACA were a child, now ten years old, it would have been reported to Child Protective Services long ago for neglect, and outright abuse. Krugman says, “the program has been remarkably stable when you bear in mind that it’s being administered by people trying to make it fail.” In spite of being deeply compromised from the start, threatened at every turn, and actively undermined by all three branches of government today, the ACA has a 55% approval rating among 327.2 million Americans. COVID-19 may just provide a historic shift that leads to better long-term policy.
‘The times they are a changin’. –Bob Dylan
As the COVID-19 response unfolds, the 10-year birthday of the Affordable Care Act passes quietly this week. Getting a national health care bill of any sort passed was an epic story covering decades. The ACA was passed at a unique moment. Some are beginning to recognize that we are at another unique moment now as both “sides” of the aisle may bend to the arc of history. That arc is not clear, but it is already shaking up calcified positions. Like Mitt Romney proposing fringe ideas proposed by Andrew Yang of a monthly stipend, now likely to be adopted temporarily by Congress. Access to health care, unemployment and paid sick leave are suddenly paramount in this emergency. What else will change?
As was obvious during the Great Depression, World War II and through the Civil Rights movement, as well as when the raft of environmental laws passed in the early 1970s that America needs a robust federal government to protect the health and welfare of its citizens, often to protect citizens from the motivations of the private sector. It was during the Nixon administration that we took action to protect our air and rivers polluted because of an unregulated industry. Today’s EPA is running back on that. With this pandemic, we may be at such an inflection point in history where a shift may become obvious to citizens even as we are being guided through this crisis by an administration that does not believe in any of those noble purposes. That is a recipe for change.
Krugman argues that a reflexive notion cultivated since those times is that the Federal (and by extension all government) are bloated, ineffective and unnecessary has become the ideology of default for many. We have reached a strange state of affairs where one “side” wants the federal government to actively solve big problems, and the other “side” can succeed simply by obstructing just to show how ineffective and obtuse government can be. Indeed, I use quotations on “sides” because, hopefully, we may come to realize that these “sides” also represent a false dichotomy, because now especially, we need the federal government to “succeed” during this pandemic, regardless of who is in charge.
A more unified government, clear in purpose would be actively shoring up the ACA to make sure the increasing number of unemployed and contract workers have insurance so that access to health care would no longer be another factor during this crisis. Maybe we will see progress on that by the time ACA turns 11.
